Hospital Acquired Infections (HAI) – a necessary evil or something that can be prevented

The term Hospital Acquired infections (HAI) refers to any infection that has been contracted while in hospital.

HAI’s include a wide spectrum of infections. Data has revealed that HAI are one of the leading causes of death in acute care hospitals in the US and account for nearly 1.75 to 2 million infections per year, causing about 98,987 deaths per year and leading to an increase in the Length of stay in the hospital by about 7.5 million days which is alarmingly large. According to the WHO fact sheet on HAI out of every 100 hospitalized patients at any given time, seven in developed and ten in developing countries will contract at least one health care associated infection

We don’t have statistics for our country yet as very few healthcare organizations have begun collecting this type of data. When compared to the number of existing healthcare facilities in India we will not be able to extrapolate the data and project it as an overall figure, but I am sure the numbers would not be less than the numbers that the US currently has. Considering the huge gap between the demand and availability of healthcare facilities in our country this additional burden is totally unnecessary.

One way to prevent HAI is to implement a strong and robust Infection Control Program in the hospital. A few proactive steps that hospitals can take are:

Forming a multidisciplinary Infection Control committee (should include representation from Leadership, Physicians, Nursing, Pharmacy, Dietetics, Housekeeping, Engineering, CSSD) and should be headed by a qualified individuaL.

The next step is for each hospital to define its Infection Control Plan for the year, based on the risk assessment performed. This plan should be able to define the scope and function of the program.

A thorough Risk Assessment will help prioritise the areas to focus upon by identifying the type of infections in the community, the type of patient populations admitted in the hospitals, the rates of the commonly acquired HAI in the hospital. This will help the hospital define its Infection Control Plan.

The risk assessment should help identify the priorities for the Infection Control Program.

Once the priorities are identified it is extremely important to set objective goals in terms of performance on what the focus of the Infection Control Program should be.

Once goals are set strategies should be defined to help move towards the defined goals. For example if the goal is to improve the hand hygiene compliance by 10 per cent over the current compliance the various strategies to accomplish this should be defined.

The Infection Control Plan should be evaluated periodically to ensure that once defined targets are met the benchmark is raised or if the targets are not being met an analysis needs to be done to ascertain the reasons of the same and course correction need to be implemented.

Most of the time construction activities are not included in the Infection Control Program, which is not a safe practice. The infection control committee has to be informed about any constructions being planned in the hospital as they need to evaluate the construction activity sometimes known as ICRA i.e. Infection Control Risk Assessment and based on whether it’s a Type A or B or C or D activity different infection prevention measures would be specified.

The most important fact regarding HAI is that most of them can be prevented by practicing simple evidence based practices like proper hand hygiene techniques, implementing a series of steps sequentially know as bundles to prevent commonly acquired HAI like the ventilator associated pneumonia, surgical site infections, UTI, CRBSI’s etc.

By proper hand hygiene I mean practicing the defined technique each and every time as stated by the guidelines CDC or WHO, whichever the hospital has defined. Many healthcare professionals practice hand hygiene but the key is to practice it always, not when the infection control nurse or associate is around as is the practice in many healthcare organizations around the world. Implementing bundles has to go beyond the existing practice I have noticed in many health care organization where ticking the bundle checklist in the end is a requirement for the quality department rather than implementing each step, checking the required column of the checklist and then moving to the next step.

Implementing a robust antibiotic stewardship program will go a long way in reducing the burden of antimicrobial resistance that has emerged in the community as we see the indiscriminate use of antibiotics in treating ailments. The Chennai declaration with regards to antimicrobial stewardship is the first large scale awareness program Infection control specialists in India have taken towards eradicating antimicrobial resistance and I urge hospitals to implement an antibiotic stewardship program in their hospitals.

I would like to conclude by saying that irrespective of whether we are a large corporate hospital providing complex tertiary or quaternary care, a government hospital or a small nursing home, our endeavour should be to ensure that “No one should contract an infection in the hospital that they did not have when they arrived”.

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